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Balhaddad AA, AlGhamdi N, Alqahtani M, Alsulaiman OA, Alshammari A, Farraj MJ, Alsulaiman AA. Predictors of procedural errors in class II resin composite restorations using bitewing radiographs. Saudi Dent J 2024; 36:638-644. [PMID: 38690396 PMCID: PMC11056429 DOI: 10.1016/j.sdentj.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 05/02/2024] Open
Abstract
Objective To identify the potential factors that induce procedural errors during posterior proximal resin composite restorations placed by dental students. Materials and Methods This retrospective study evaluated 803 bitewing radiographs of posterior proximal resin composite restorations placed by dental students at Imam Abdulrahman bin Faisal University. Atypical radiographic signs of failure were screened, and different patient-, operator-, and clinical-related factors were recorded. Chi-square test was used to examine the relationship between procedural errors and recorded factors. Stepwise adjusted logistic regression model was performed to identify predictors of procedural errors. Results The most observed errors were internal gaps at the bonding interface and internal voids. Molars had 0.39 the risk of internal voids (odds ratio [OR] = 0.39; confidence interval [CI] = 0.25-0.60; P = <0.0001), 0.41 the risk of sharp angle (OR = 0.41; CI = 0.24-0.68; P = <0.001), and 0.57 the risk of open contact (OR = 0.57; CI = 0.34-0.97; P = 0.04) compared to premolars. Those who were >40 years of age had 1.79 the risk of overhang compared to younger patients (OR = 1.79; CI = 1.04-3.11; P = <0.04). First molars and premolars had 0.64 the risk of overhang compared to second molars and premolars (OR = 0.64; CI = 0.41-1.00; P = 0.04). Junior students had 1.97 the risk of internal gap compared to their senior counterparts (OR = 1.97; CI = 1.20-3.21; P = 0.008). Mesial restorations had 0.38 the risk of external gap compared to mesio-occluso-distal (MOD) restorations (OR = 0.38; CI = 0.19-0.78; P = 0.003). Restorations with a margin coronal to the cemento-enamel junction (CEJ) had 0.44 the risk of external gap compared to those restorations with a margin apical to the CEJ (OR = 0.44; CI = 0.29-0.66; P = <0.0001). Conclusion Our findings suggested a higher incidence of procedural errors in restoring premolars and MOD cavity preparations. Therefore, it is crucial to enhance the comprehensiveness of laboratory training and expose students to diverse clinical scenarios and various techniques.
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Affiliation(s)
- Abdulrahman A. Balhaddad
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Nawaf AlGhamdi
- Internship Program, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Mohammed Alqahtani
- Internship Program, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Osama A. Alsulaiman
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Ali Alshammari
- Dental Hospital, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Malik J. Farraj
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Ahmed A. Alsulaiman
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
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Gancedo-Gancedo T, Martín-Biedma B, Domínguez-Cachón J, Garrido-Parada S, Ababii V, Pereira-Lores P, García-Varela S, Castelo-Baz P. New Technique for Wedge Selection in Direct Class II Restorations: A Pilot Study. J Clin Med 2024; 13:1324. [PMID: 38592699 PMCID: PMC10931775 DOI: 10.3390/jcm13051324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/09/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Performing an appropriate Class II direct restoration is a great challenge. The correct selection of the matrix system and the elements used for its stabilization will have a great impact on the result. The aim of this study is to show a new digital method for a predictable selection of the wedge and compare it with the conventional method. Methods: Sixty patients were randomly divided into two groups. In Group 0, the wedge was selected intraoperatively by visual examination, while in Group 1 the wedge was selected preoperatively through the measurement of the cervical embrasure on the bite-wing radiography. The number of wedges used, modifications to them, and tissue damage were registered, along with the quality of the proximal contact and the marginal adaptation. Results: Student's t-test revealed a statistical difference between the number of wedges used, which was higher in Group 0 (p < 0.05). Pearson Chi-square test showed that tissue damage was statistically higher in Group 0 (p < 0.05), while there was no statistically significant difference between groups in wedge modifications (p > 0.05). Group 1 revealed a higher frequency of satisfactory proximal contact and marginal adaptation (p < 0.05). Conclusions: This new technique reduces wedges waste and tissue damage and provides an adequate interproximal anatomy.
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Affiliation(s)
- Tania Gancedo-Gancedo
- Endodontics and Restorative Dentistry Unit, School of Medicine and Dentistry, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; (J.D.-C.); (S.G.-P.); (P.P.-L.); (S.G.-V.)
| | - Benjamín Martín-Biedma
- Oral Sciences Research Group, Endodontics and Restorative Dentistry Unit, School of Medicine and Dentistry, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; (B.M.-B.); (P.C.-B.)
| | - Javier Domínguez-Cachón
- Endodontics and Restorative Dentistry Unit, School of Medicine and Dentistry, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; (J.D.-C.); (S.G.-P.); (P.P.-L.); (S.G.-V.)
| | - Sara Garrido-Parada
- Endodontics and Restorative Dentistry Unit, School of Medicine and Dentistry, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; (J.D.-C.); (S.G.-P.); (P.P.-L.); (S.G.-V.)
| | - Victoria Ababii
- Department of Odontology, Periodontology and Oral Pathology, Nicolae Testemițanu State University of Medicine and Pharmacy, 2004 Chișinău, Moldova;
| | - Patricia Pereira-Lores
- Endodontics and Restorative Dentistry Unit, School of Medicine and Dentistry, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; (J.D.-C.); (S.G.-P.); (P.P.-L.); (S.G.-V.)
| | - Sandra García-Varela
- Endodontics and Restorative Dentistry Unit, School of Medicine and Dentistry, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; (J.D.-C.); (S.G.-P.); (P.P.-L.); (S.G.-V.)
| | - Pablo Castelo-Baz
- Oral Sciences Research Group, Endodontics and Restorative Dentistry Unit, School of Medicine and Dentistry, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; (B.M.-B.); (P.C.-B.)
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Bailey O, Shand B, Ellis I. Class II composite restoration technique teaching: A randomised controlled crossover laboratory-based trial involving a novel ringless sectional matrix technique. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:963-973. [PMID: 36539980 DOI: 10.1111/eje.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/11/2022] [Accepted: 10/30/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Objectives were to assess how different techniques (including a novel ringless sectional matrix approach) affect students' restorative outcomes, and their preferences for and preparedness to clinically implement new techniques with the aim of introducing appropriate techniques to the undergraduate curriculum. MATERIALS AND METHODS Students performed two class II composite restorations in plastic teeth using two sectional matrix techniques (separating ring vs. without [ringless]), and two composite restorative techniques (incremental vs. injection-moulded bulk-fill). Restorations were assessed on multiple parameters which were combined to rate them as "good" or not. Online surveys assessed students' preferences for and preparedness to clinically implement new techniques. RESULTS Contact area concavity (OR = 106, p < .001) and cervical marginal overhang (OR = 7.4, p < .001) were much more likely with the separating ring compared to the ringless sectional matrix technique. "Good" restorations were 29.5 times more likely when using ringless compared to separating ring techniques and 3.3 times more likely when using the injection-moulding bulk-fill compared to layered composite technique. A majority of students preferred the ringless to separating ring sectional matrix technique and the injection-moulding bulk-fill to layered composite technique. Large majorities felt prepared to implement the new techniques clinically with no or minimal guidance. CONCLUSIONS A classic sectional matrix technique with separating ring resulted in a much greater occurrence of contact area concavity and cervical marginal overhang than a novel ringless approach. When allied with student preferences and clinical preparedness, inclusion of the novel ringless approach in the undergraduate curriculum can be supported alongside bulk-fill injection-moulding techniques.
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Affiliation(s)
- Oliver Bailey
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Bonnie Shand
- Dental Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian Ellis
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Abbassy KM, Elmahy WA, Holiel AA. Evaluation of the proximal contact tightness in class II resin composite restorations using different contact forming instruments: a 1-year randomized controlled clinical trial. BMC Oral Health 2023; 23:729. [PMID: 37805456 PMCID: PMC10559497 DOI: 10.1186/s12903-023-03462-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Proper proximal contact in direct composite restorations is crucial for periodontal health. Over a one-year period, this study was conducted to assess successive biological changes in proximal contact tightness PCT in class II direct composite restorations and the adjacent teeth by applying sectional matrix system along with different contact forming instruments. METHODS 72 direct compound class II composite restorations were performed in patients aged 18-40 years and divided into 4 groups: Group I (n = 18): proximal contact was restored with Palodent plus sectional matrix system, Group II (n = 18): Trimax as contact forming instrument, Group III (n = 18): Perform as contact forming instrument and Group IV (n = 18): Contact pro as contact forming instrument. All contact forming instruments were used along with Palodent plus matrix system. PCT was measured using a digital force gauge before (T0), immediate post operative (T1) and at 3 (T2), 6 (T3), 9 (T4), and 12 months (T5) after restorative treatment. Using One-Way ANOVA, Tukey's post hoc test, and Bonferroni correction, PCT values were compared between groups before and after the intervention restoration. Meanwhile, for comparisons within groups, a paired t-test was conducted (p ≤ 0.05). RESULTS Contact forming instruments combined with Palodent plus sectional matrix system achieved better PCT. Trimax led to a statistically considerable tighter proximal contacts than the other groups (p < 0.05). No statistically significant difference was found in PCT between Contact pro-2, Perform and Palodent plus sectional matrix system. By means of multivariate analysis, the PCT between both T0 and T1 were increased (p < 0.001) and then it decreased till T5. CONCLUSIONS The use of transparent contact forming instruments achieved greater PCT compared to Palodent sectional matrix system alone that gradually decreased throughout 12 months and reached the PCT between the natural teeth. Using Trimax system provided the tightest proximal contacts. Additionally, digital force gauge was confirmed as an inclusive and accurate method to quantify PCT. TRIAL REGISTRATION ClinicalTrials.gov NCT05749640: 24/5/2022.
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Affiliation(s)
- Karim M Abbassy
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Waleed A Elmahy
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Ahmed A Holiel
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
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Tolba ZO, Oraby E, Abd El Aziz PM. Impact of matrix systems on proximal contact tightness and surface geometry in class II direct composite restoration in-vitro. BMC Oral Health 2023; 23:535. [PMID: 37533048 PMCID: PMC10399026 DOI: 10.1186/s12903-023-03222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Poor contact tightness and contour in class II composite restorations are significant problems in clinical practice. They affect occlusal stability and periodontal health. The aim of this study was to evaluate proximal contact tightness and contour established after completing class II direct composite restorations using two pre-contoured matrix systems. METHODS Standardized mesio-occlusal cavities were prepared in twenty typodont lower right first permanent molar teeth. Prepared teeth were randomly divided into two groups according to matrix system: Group 1, Sectional matrix system with a separation ring (Palodent V3); and Group 2, Circumferential matrix system with integrated tightener (Palodent 360). Contact tightness was evaluated using universal testing machine. Area, depth and curvature radius of proximal surface concavity in the restoration were evaluated using contact stylus profilometer. T-test was used for comparison between groups. RESULTS Sectional matrix showed higher contact tightness than circumferential matrix system. The results of proximal surface concavity in the restoration showed significantly higher area and depth of concavity with lower radius of curvature in circumferential matrix compared to sectional matrix. CONCLUSIONS The use of separation ring with sectional matrix provides superior contact tightness compared to circumferential matrix. However, both matrix systems presented some deficiency regarding proximal contour of direct class II resin composite restoration.
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Affiliation(s)
- Zeinab Omar Tolba
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Ezzat Oraby
- National Institute of Standards (Engineering and Surface Metrology), Giza, Egypt
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Korkut B, Tüter B, Tağtekin D. Composite plastering technique (CPT) for anterior and posterior restorations. BALKAN JOURNAL OF DENTAL MEDICINE 2023. [DOI: 10.5937/bjdm2301008k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Composite plastering technique (CPT) is a novel restoration improvement technique for eliminating and re-contouring the marginal defects. Restoration-related interproximal contour deficiencies such as dark triangles beneath the contact point following direct class II restorations, the gaps at the interproximal cavity step following indirect cementations, and the gaps at the interproximal wall following class III restoration layering procedures can be corrected using the CPT. The technique may also be used as a layering step during the free-hand layering in diastema closure restorations. Contour deficiencies on interproximal surfaces which lead to the renewal of restoration and periodontal damages can be prevented by additional direct composite build-up using the CPT. The technique can be performed either immediately after the restoration directly or long after by using the composite repair protocol. It focuses on filling and re-contouring the surface of the deficiency by using a mylar strip actively under rubberdam isolation. Composite is loaded between the strip and the tooth surface and the strip is pulled slightly in palato-buccal or the opposite direction depending on the location of the defect, to fill it by plastering the composite. It may contribute the longevity of the restoration by improving the emergence profile and correcting the interproximal contour. Re-contouring of the interproximal surface defects by CPT is a useful approach to improve the esthetics as well as the function of anterior and posterior direct and indirect restorations which may also prolong the longevity.
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Elgezawi M, Haridy R, Abdalla MA, Heck K, Draenert M, Kaisarly D. Current Strategies to Control Recurrent and Residual Caries with Resin Composite Restorations: Operator- and Material-Related Factors. J Clin Med 2022; 11:jcm11216591. [PMID: 36362817 PMCID: PMC9657252 DOI: 10.3390/jcm11216591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
This review addresses the rationale of recurrent and/or residual caries associated with resin composite restorations alongside current strategies and evidence-based recommendations to arrest residual caries and restrain recurrent caries. The PubMed and MEDLINE databases were searched for composite-associated recurrent/residual caries focusing on predisposing factors related to materials and operator’s skills; patient-related factors were out of scope. Recurrent caries and fractures are the main reasons for the failure of resin composites. Recurrent and residual caries are evaluated differently with no exact distinguishment, especially for wall lesions. Recurrent caries correlates to patient factors, the operator’s skills of cavity preparation, and material selection and insertion. Material-related factors are significant. Strong evidence validates the minimally invasive management of deep caries, with concerns regarding residual infected dentin. Promising technologies promote resin composites with antibacterial and remineralizing potentials. Insertion techniques influence adaptation, marginal seal, and proximal contact tightness. A reliable diagnostic method for recurrent or residual caries is urgently required. Ongoing endeavors cannot eliminate recurrent caries or precisely validate residual caries. The operator’s responsibility to precisely diagnose original caries and remaining tooth structure, consider oral environmental conditions, accurately prepare cavities, and select and apply restorative materials are integral aspects. Recurrent caries around composites requires a triad of attention where the operator’s skills are cornerstones.
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Affiliation(s)
- Moataz Elgezawi
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
- Correspondence: (M.E.); (D.K.); Tel.: +49-89-4400-59452 (D.K.); Fax: +49-89-4400-59302 (D.K.)
| | - Rasha Haridy
- Department of Clinical Dental Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
- Department of Conservative Dentistry, Faculty of Dentistry, Cairo University, Cairo 4240310, Egypt
| | - Moamen A. Abdalla
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Katrin Heck
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethe Str. 70, 80336 Munich, Germany
| | - Miriam Draenert
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethe Str. 70, 80336 Munich, Germany
| | - Dalia Kaisarly
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethe Str. 70, 80336 Munich, Germany
- Correspondence: (M.E.); (D.K.); Tel.: +49-89-4400-59452 (D.K.); Fax: +49-89-4400-59302 (D.K.)
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Matrix transfer techniques for direct paste composite resins. Br Dent J 2022; 233:91-98. [PMID: 35869203 PMCID: PMC9307475 DOI: 10.1038/s41415-022-4447-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022]
Abstract
This article discusses potential concerns and important considerations when selecting and using matrix transfer techniques for the direct, definitive addition of composite resin to teeth. It also provides guidance to aid these processes with the use of case studies, primarily focusing on the management of tooth wear. Considers the advantages and disadvantages of using different matrix transfer techniques for the restoration of multiple teeth with direct paste composite. Addresses common concerns and problems associated with using matrix transfer techniques, particularly in relation to managing the worn dentition. Suggests guidance on selecting appropriate matrix transfer techniques to minimise complications and optimise outcomes through the exploration of case studies.
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Hall AF. Reflections from undergraduate teaching experiences: some problems and solutions of restoring teeth with dental resin composite instead of dental amalgam. Br Dent J 2022; 232:607-610. [PMID: 35562451 DOI: 10.1038/s41415-022-4201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/21/2022] [Indexed: 11/09/2022]
Abstract
This is a simple personal reflection on some of the problems and solutions related to the increasing use of composite resin to replace dental amalgam when dental students learn to place restorations at the start of their careers. To the author, much seems common sense. Much is not, or cannot, be backed up by ideal science and some may still be considered outdated to the more progressive practitioner. Unfortunately, prospective, ideally-designed clinical trials may no longer be possible to seek the answers we lack due to ethical, organisational, financial or other constraints.
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Affiliation(s)
- Andrew F Hall
- Unit of Restorative Dentistry, Dundee University Dental School, Dundee, DD1 4HR, UK.
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